Inappropriate use of GLP-1-based antiobesity medications: beyond appropriate drug use toward appropriate weight...

Glucagon-like peptide-1 (GLP-1) receptor agonists and glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor dual agonists have transformed obesity treatment, but their widespread use has been accompanied by increasing medically inappropriate use for weight loss. Current efforts to promote the appropriate use of GLP-1-based medications have largely focused on regulatory compliance related to off-label prescribing and illegal acquisition. However, recent reports of serious health consequences associated with inappropriate tirzepatide use suggest that these events may arise not only from the intrinsic toxicity of these medications but also from inappropriate dietary restriction and inadequate medical supervision during weight-loss attempts. We argue that inappropriate use should be understood from two complementary perspectives: regulatory appropriateness and medical appropriateness. Medical appropriateness encompasses not only drug-related risks but also the safety of weight reduction itself. Emerging concepts such as female underweight/undernutrition syndrome further emphasize that weight reduction should be evaluated not only by its magnitude but also by its nutritional and clinical consequences. We propose that the discussion surrounding GLP-1-based therapies should move beyond appropriate drug use toward appropriate weight reduction, regardless of whether weight loss is pursued to improve obesity-related health conditions or for cosmetic purposes.